Considering Quitting With Current Therapist

[joeylittle]

Or, wouldn't it have been better for him to follow through with calling me to at least set up a plan until we could discuss his changed terms in our next session?

Absolutely - but no one is perfect, even therapists.

It truly sounds to me like he got a big scare, when he got your message, and he is now working through how to handle things going forward.

My only point is that you both made mistakes. Now, you are paying him to make as few mistakes as possible; but I don't think this is a situation where either of you has the moral high ground, and thinking about it in terms of what he did 'wrong', won't do much to help how you decide to move forward (or not to move forward). Neither of your behaviors were justifiable, but both were very understandable (if that makes sense).

What bothers me is the lack of a safety plan or safety contract after your first encounter with suicidal intent. That tells me that he may not be experienced enough to provide the kind of crisis support you might be looking for.

If you were asked to outline what you wanted from him, going forward (re: crisis support) - what would it be?

 

[Suzetig]

In essence, I get I f*cked up, but it sucks to be punished for the rest of my life for it.

I understand that it feels like your T is punishing you but it sounds like she's redrawn her boundaries because she got a fright and realised she can't be in a place where she offers support in a crisis. Better she's honest about that and you know your options in terms of what to do in a crisis than her not be there when you need her.

I've worked in a role that involves working with people who are suicidal - it's hard to explain just how awful it is as a professional to receive communication from someone saying they're actively suicidal and then to not be able to reach them. It's literally heart stopping. Really clear boundaries are so essential for the individual but also for the professional in whatever role - it's too easy to get pulled in to trying to rescue and sometimes it's not til something happens that you realise you need to change things to preserve your own wellbeing and to ensure you can still offer some kind of support to the people you work with.

That's not about punishment but about safety for everyone concerned.

 

[kilted]

I suspect your therapist is inexperienced. Mobile phones have given us this impression of being "always on", but losing a phone, lack of connectivity in a building or area and something as simple as a long phonecall draining the battery can render either client or therapist unobtainable.

The problem here lies with the therapist in that they got themselves into a position of being "first point of contact" for you in times of emergency. As a previous poster has said, the therapist role involves setting firm boundaries around this stuff, usually through some form of "No suicide" contract.

The difficulty is that trust has been broken, which is exactly the problem if boundaries are not set explicitly at the beginning of therapy. The "exposure" process you describe is perfectly normal in some types of therapy, but the impression given that this was something "special" he did for you and not other clients again indicates his inexperience.

This is a situation he would have avoided if he was in regular contact with a supervisory therapist. When you meet him, ask him to go and talk your case over with one ASAP.

 

[Deleted member 40384]

Absolutely - but no one is perfect, even therapists.

It truly sounds to me like he got a big sca...

I can see what you're saying and it makes sense to me - what I want to talk about in the next session is less of what he did wrong (in an accusatory manner), and more of what we did that didn't work, or wasn't effective.
In his message last week, he gave me a rough outline of what to put on a safety plan, but I looked on various websites to try to get a better sense of the layout. First I have my regular coping skills (things like going for a walk, or reading), then if those don't work I have a list of people I can contact (my T and my partner). In the event that I feel like I can't keep myself safe, I would ask either T or my partner to call 911. I don't feel comfortable calling 911 (social phobia), so I need to have a plan for that if I can't reach my contacts. Maybe if the next step would be to call the suicide hotline? I think I would need to write out a preliminary script that would make calling easier?

 

[Deleted member 40384]

I suspect your therapist is inexperienced. Mobile phones have given us this impression of being "always...

My T works with a huge team at the clinic, where he's in regular communication. He's not supervised directly, but I would think that he brought this up, at some point.
I agree that there should have been clear boundaries and a safety plan written out after what happened a couple months ago - from reading some research, it seems though that a safety plan is better than a no-suicide contract, if I comprehended that correctly. I would like to be able to talk about my suicidal thoughts and urges without feeling like I need to suppress them or hide them out of fear or shame - the distinction needs to be made, though, that I can experience the thoughts and urges while both T and I have the understanding that I won't act on them, and that if I feel like it's beyond my control, I will feel comfortable implementing the safety plan. Is that a reasonable thing to bring up in the next session? Will that make my T feel less panicked when I do talk about suicidal thoughts and urges, because he is confident that a safety plan has been well-established?

 

[kilted]

It's important to be able to talk about your suicidal thoughts. Not feeling able to talk about such things inevitably affects the therapeutic relationship over time.

If your therapist is working in a large clinic it doesn't always mean they talk about cases, however in my country a large organisation providing front line psychotherapeutic support would have a suicide policy which the therapist would be bound to follow, and a therapist would be expected to talk over risky or problematic cases with the counselling manager. This is all part of the boundaries talk and made clear at the beginning of therapy. When you meet your therapist, ask about the policy of the clinic..... there will be one.

It may be, that having had this shock, the therapist has now realised he has to follow his centre's guidelines and is backpedalling. It's fine to talk about how you feel, however it's helpful to remember that you don't have all the info about the therapist's end. Over here it is thought unusual if a client in crisis phones a therapist out of hours. Many therapists work out of clinics that aren't 24/7 and the client is never given the therapists private number. A previous private (non-clinic) therapist of mine never answered the phone, so you only ever got an answering machine... then they would phone back (They also didn't do email...!).

 

[Deleted member 40384]

It's important to be able to talk about your suicidal thoughts. Not feeling able to talk about such thin...

There is a policy at the clinic, but I'm pretty sure it only applies to clinicians completing their fellowship. Those steps include: that the therapist needs to adequately assess suicide risk, ensure that there is a plan in place as to what the client is going to do to get through the crisis, etc. He didn't follow that protocol, so either it doesn't apply to him, or he put something different in his therapy notes.
I forgot to say that T gave me his mobile number from the get-go and that I've been encouraged to use it if I need to. A lot of clinicians at his clinic offer this, but insurance doesn't pay for it. He does everything for me for free, which is so incredibly nice of him. During periods where things are more difficult for me, he checks in anywhere from 2 to 6 times a week, and talks to me anywhere from 5 minutes to an hour. I don't think he does that for his other clients to that extent. I'm appreciative that he does that. At the same time, I don't want these things to act as a deterrent for me to talk about what's bothering me or to address mistakes made on his part. I'm afraid to lose the relationship because I can almost guarantee I will not find a T who does these extra things. It makes me feel dependent on the relationship, even more so because I have attachment issues from an abusive childhood.

 

[Suzetig]

Any time I hear someone recognising that what their T does leaves them feeling dependent on the relationship, I see alarm bells ringing. Some level of dependency is part and parcel of therapy but he should be supporting you to build a support network away from him.

Some Ts do give personal contact details - I've always had my (UK) therapists mobile number and she always responds to me. That's on the understanding that she doesn't do therapy by text or email, if I'm in crisis I use more immediate supports and if there something I need to properly talk about, I book an extra session with her - which she's fitted in at very short notice when I've asked. She absolutely wouldn't be ok with me texting out of hours to say I was suicidal - she would deal with it at the time and we'd talk about it later and our relationship would be ok but I'd expect the boundaries to be redrawn.

Each client needs something different from their T and it's good that your T tries to respond to you. I know it makes you feel special but at the level he's doing it, it actually sounds more like he's let his boundaries slip. That's fixable but means some hard conversations that should see a shift in your relationship towards you being more independent. If you're needing him to check in with you that frequently, I'd think the pace of work is off kilter or you need more intensive support than once a week therapy.

A safe plan can be a good thing that can facilitate you being able to talk about suicide but it needs not to rely on him phoning emergency services and needs to delineate between "I'm really struggling and finding coping hard, I have supports but need to talk about whether they're enough" and "I literally can't keep myself safe".

 

[Deleted member 40384]

Any time I hear someone recognising that what their T does leaves them feeling dependent on the relatio...

I check in with T about his level of comfort and boundaries surrounding checking in with me so often, and he has always said that he is fine with it, and that he wants to do it. Maybe he feels differently though, or doesn't know entirely how he feels about it. He does change around plans a lot, and that wouldn't bother me if I wasn't so dependent or that my expectations weren't so high. I've been mentally lowering my expectations and working on gaining more independence mentally, because it's unhelpful to feel like I'm relying on T for most decisions and insights. He's been encouraging me to expand my support and social connection, but it's a tricky and complex thing because of social phobia obstacles. I sought out an EMDR therapist who I'm seeing for the first time next week, and my T is supportive of me getting more help. T and I haven't addressed my trauma in a structured way, so maybe this will put me on a positive track.
So in the safety contract, should I remove the part about contacting T or my partner to call emergency services? If I feel I literally can't keep safe, should I jump straight to calling the hotline? Or, calling 911 myself - I don't know if I could do that, maybe if I had written out what I would first say?

 

[Suzetig]

I'm not sure it's about removing it but maybe having some boundaries around it for example - "if I feel like this during the working day I'll call T, if it's in the evening I'll speak to my partner. If I'm in crisis and contact my partner or T they will always do "x" (phone emergency services). If I can't get either of them or I'm in crisis overnight or whenever I'll call a hotline and ask them to call emergency services and talk to me until help arrives."

Basically a good safe plan has layers and contingencies and everyone knows what they need to do as part of the plan and most importantly you know what they'll do because you've agreed it when you aren't in crisis.

As far as your T goes, it's not your job to check that they're ok with how they work with you - it's your Ts job to monitor their work with you. In the U.K. That would be fine via a formal clinical supervision arrangement but I know things differ in the US. My "red flag" comment wasn't about you needing to do anything differently or being wrong, it was more about helping you listen to the parts of you that seem to be starting to wonder about your T and the way he's working with you around the things that feel special - and who wouldn't want to feel special - but which can get in the way of the therapy you need him to provide.

 

[Deleted member 40384]

I'm not sure it's about removing it but maybe having some boundaries around it for example - "if I feel...

Thanks, I just finished the safety plan and I think it will work out for all parties involved. I'll bring it in with me to my session tomorrow.
For a while I've been feeling like the neediness of my relationship with T is hindering my progress, and making it so I feel like I can't rely on myself - which I'd like to change. I'm worried, though, that he is going to rescind the things he does outside of session - that would feel much worse for me than if I decided on my own to get some distance by not asking him to check in so often, or not sending him so many e-mail updates. I have a tendency to want his approval for everything I do, which relates to the attachment issues.

 

[Suzetig]

That can be about attachment, it can also be about trauma - we sometimes recreate relationship dynamics that are similar to those we had during trauma. Not on purpose, we're often totally unaware of it until we take a step back and realise we feel dependent, or that someone is being controlling or whatever. I wonder if it might help to think about it as a process of negotiation. So, he isn't taking things away and you're not saying you don't need him - but the relationship needs to develop and change so that you have more room?

Sounds like you've come a long way in processing what was happening in your relationship with him and what you need now - you've done such a good job working through it.